Articles: chronic-pain.
-
Chronic pain--especially that which is refractory to conventional treatment--presents particular challenges to physicians and patients. Examination of the molecular and cellular mechanisms involved in this pathophysiology suggests that spinal instillation of therapeutic agents may offer an effective treatment option through the modification of the processing and sensation of chronic pain. ⋯ This article reviews chronic pain pathophysiology and the mechanisms whereby spinally administered analgesics may modify chronic pain. Available treatment options are also considered, including recommendations from the 2007 Polyanalgesic Consensus Conference (PACC) guidelines on the use of intrathecal agents for nociceptive, neuropathic, and mixed pain.
-
Eur J Phys Rehabil Med · Feb 2013
Review Comparative StudyThe utilization of opiates in pain management: use or abuse.
Despite governmental regulations, opiate medications continue to be abused in some populations. Some clinicians have advocated non-opioid therapy for pain patients that suffer from non-malignant conditions; while others have suggested that chronic benign pain conditions may successfully be managed with opiates in non-escalating dosages. ⋯ Studies demonstrating functional improvements with the utilization of opiate medications are also lacking. Physical Medicine and Rehabilitation researchers therefore have an ideal opportunity to positively influence education, regulation and patient care in this field.
-
Spinal fusion is a common but controversial treatment for chronic low back pain (LBP) with outcomes similar to those of programmed conservative care. To improve the results of fusion, tests for patient selection are used in clinical practice. ⋯ No subset of patients with chronic LBP could be identified for whom spinal fusion is a predictable and effective treatment. Best evidence does not support the use of current tests for patient selection in clinical practice.
-
Mayo Clinic proceedings · Feb 2013
ReviewTopical analgesics in the management of acute and chronic pain.
Oral analgesics are commonly prescribed for the treatment of acute and chronic pain, but these agents often produce adverse systemic effects, which sometimes are severe. Topical analgesics offer the potential to provide the same analgesic relief provided by oral analgesics but with minimal adverse systemic effects. This article describes the results of a systematic review of the efficacy of topical analgesics in the management of acute and chronic pain conditions. ⋯ Strong evidence was identified for the use of topical diclofenac and topical ibuprofen in the treatment of acute soft tissue injuries or chronic joint-related conditions, such as osteoarthritis. Evidence also supports the use of topical lidocaine in the treatment of postherpetic neuralgia and diabetic neuropathy. Currently, limited evidence is available to support the use of other topical analgesics in acute and chronic pain.
-
Clinical rheumatology · Feb 2013
Pain and psychological health status in chronic pain patients with migration background--the Zurich study.
The objective of this paper is to investigate whether there were differences in pain and psychological health status in chronic pain patients with and without migration background before and after an 8-week interdisciplinary outpatient pain programme (IOPP). One hundred eighteen consecutively assessed patients were included. Pain and psychological health were recorded prior to and after the intervention, and at the 3-, 6- and 12-month follow-up. ⋯ The results show differences in outcome for chronic pain patients with and without migration background. High pain intensity, high levels of depression, anxiety and catastrophizing at baseline appear to be major barriers for improvement in a sample of migrant patients when participating in an IOPP. Treatments may have to be tailored to the specific needs of this patient group to better address their poor psychological health status and to improve the course of the pain disorder.